Food is Medicine: Integrating Food Assistance into Safety-Net Health Care Makeover Montgomery Thursday May 10, 2018 1
Food is Medicine:Integrating Food Assistance into Safety-Net Health Care
Makeover Montgomery
Thursday May 10, 2018
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Food is Medicine
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The Food Is Medicine project is a part of the Transforming
Communities Initiative (TCI), focused on making policy, system,
and environment change to improve health.
The Food is Medicine project aims to:
Create a permanent pathway that effectively links the
safety-net health care programs in Montgomery County with
food assistance & nutrition education services.
Primary Care Coalition
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The Primary Care Coalition of Montgomery County (PCC) works
to build and strengthen systems that can improve the health of
all community members.
PCC manages public-private partnerships to deliver high-quality
health care services and strengthen
Uninsured and Underinsured in Montgomery County
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Since implementation of the
Affordable Care Act (ACA) began
in 2014, the uninsured population
has declined significantly.
Still tens of thousands of people
without health insurance.
Uninsured and Underinsured in Montgomery County
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People of color in Montgomery
County are much more likely to be
uninsured than Non-Hispanic
White residents.
• African American: 3.2 times more
likely to be uninsured
• Asian: 2.1 times more likely to be
uninsured
• Hispanic/Latino: 9.9 times more
likely to be uninsured
Uninsured and Underinsured in Montgomery County
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The populations with high uninsured rates also face more risk factors to
their long-term health.
• Hypertension: 33% of African Americans & 20% of Hispanic/Latinos
• Overweight/Obese: 68% of African American adults & 76% of Hispanic adults.
• Adolescent obesity: 25% of African American teens & 30% of Hispanic teens.
Source: Healthy Montgomery, www.healthymontgomery.org
Safety-net health care in Montgomery County
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Working with the Montgomery County Dept of Health & Human Services
the PCC administers safety-net health care programs:
Montgomery Cares serves over 24,000 uninsured adults.
Care for Kids serves over 6,000 uninsured children.
To qualify, Montgomery County residents must be uninsured and earn <250%
of poverty = ~$30,000 for a single person; ~$62,000 for a family of four.
Partnerships with eleven safety-net clinics, six hospitals, school-based
health centers, school-based health centers, and a network of volunteer
providers.
Safety-net health care
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Health care and access to primary &
preventive services are extremely
important.
But we know that health care services
alone will not close these disparities.
We must do more to address the
social determinants of health.
Food Insecurity in Montgomery County
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There are over 60,000 Montgomery
County residents who are food
insecure:
They do not have consistent
access to safe, sufficient, and
nutritious food.
Food Insecurity in Montgomery County
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The disparities in food security align with the overall health disparities:
Lower income people are more likely to be food insecure.
People of color are more likely to be food insecure.
Foreign-born residents are more likely to be food insecure.
Food Insecurity and Health
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• Hungry children get sick more often and have trouble keeping up at
school.
• Hunger leads to stress and anxiety in children and adults.
• Food insecure children are 1.4 times more likely to have pediatric
asthma
• Food insecure adults have a harder time managing chronic diseases,
like diabetes, and are twice as likely to have diabetes.
• One study estimates that food insecurity leads to over $1,800 in
additional hospital costs for each person.
Food Insecurity and Health
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The Cycle of Food Insecurity:
Lack of access to food leads
to lower cost, more filling
meals; skipping meals then
binge-eating, and reduction in
diet variety.
All contribute to chronic
disease like diabetes &
hypertension.
Food is Medicine
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The Food is Medicine project is based on a simple set of facts
described above:
• Health disparities persist in Montgomery County.
• Food insecurity contributes to these disparities.
• The population served by the safety-net clinics is also at highest risk
for food insecurity.
Food is Medicine
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The Food is Medicine program grew from an existing initiative, the Healthy
Long Branch Food Access Program managed by CHEER and developed
with funding from the Healthcare Initiative Foundation (HIF).
The Transforming Communities Initiative (TCI) funded an expansion of this
model, aiming to make a systemic change that will address food security
through the safety-net health care system.
The priority areas for TCI are Long Branch/Takoma Park and
Gaithersburg/Germantown.
Food is Medicine
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There are three primary goals to create a sustainable referral pathway
from safety-net health care programs to the food system:
1) Implement food security screening and referral in safety-net health
care providers.
2) Increase capacity for culturally appropriate care coordination after
referral.
3) Identify system & policy changes that will support screening,
referral, care coordination, & food assistance in the long-term.
Food is Medicine Partners
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Safety-net health care:• Care for Kids (CFK) program, enrollment administered by PCC
• Mobile Medical Cares, UpCounty and Long Branch sites
• Mercy Health Clinic
Food assistance and nutrition education:• Manna
• Crossroads
• University of Maryland EFNEP
• Montgomery County Food Council
Community-based care coordination:• Community Health & Empowerment through Education & Research (CHEER)
Food is Medicine Partners
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The screening for food insecurity can be shortened to just two questions:
1. In the past 12 months were you worried that food would run out without
money to buy more?
2. In the past 12 months did your food run out and you didn’t have money to
buy more?”
Asking these two questions is sensitive and valid to screen for food insecurity,
especially when used with low-income families.
Impact
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1) Are the service areas integrated?• Patients in the participating providers are routinely screened and referred to
food assistance and/or nutrition education.
• Referred patients in the target areas receive care coordination
• Referred patients access additional services after follow-up
2) Do services improve food security, eating habits, & patient health?• Reduce food insecurity among participants.
• Increase consumption of fruits and vegetables among participants.
• Lower HbA1C for diabetic participants.
3) Are the system changes sustainable?• Leaders from across sectors commit to a shared sustainability plan.
Initial Results
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Screening and Referral• By working with the Care for Kids program and two safety-net clinic partners,
Food is Medicine will be screening a total of 1,500 families annually.
Food assistance• To date, roughly 80% of patients who receive follow-up navigation after the
referral are effectively linked with food assistance.
• For those receiving more intensive interventions, there are significant health
outcome improvements.
Long Branch Support
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A part of Food is Medicine is to integrate more intensive services. The
Long Branch Healthy Food Access Program.
Targeted at diabetic and pre-diabetic residents, participants receive
additional follow-up and support, including nutrition education and three
months of weekly, no-cost food assistance.
Community partnership & engagement is essential.
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Behavior Change
Nutrition habits• None of the cohort was eating 5+ servings of fruits or 5+ servings of
vegetables at the beginning of the intervention.
• 65% increased their intake of fruits or vegetables or reduced their intake of
salty snacks or butter and margarine.
Change in outcomes
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41 participants had a before
and after measure of BMI
• 31 (76%) lost weight during
three month intervention
• Average weight loss of 8.8
pounds in three months
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Change in outcomes
21 participants had a before and after blood glucose test (HbA1c):• All were diabetic or pre-diabetic
• 11 (50%) of participants improved their blood glucose control after three
months of intervention.
• Average improvement of roughly one percentage point.
• Still tracking long-term impact.
What’s Next
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Starting the second year of the program! Expanding to new clinics.
Innovation: continue to find ways to build on existing resources to address
food insecurity.
Looking for more community partners to support integration & expansion
Business Leaders Fighting Hunger, commitment to working in East County
Thank You!
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Ben Fulgencio-Turner
Director of Coverage & Connections, Primary Care Coalition